Postoperative brain functions in infants with critical congenital heart disease via aEEG / 中华胸心血管外科杂志

Objectlve To explore the correlation between amplitude-integrated electroencephalographic(aEEG) findings and clinical features and to investigate the status of perioperative brain function in infants with critical congenital heart disease (CCHD) and its influencing factors.Methods Newborns and infants with critical CHD who were admitted to the NICU at our hospital were included.Postoperative aEEG was continuously monitored and analyzed,and its correlation with clinical conditions was compared.Results A total of 226 patients were enrolled.Of the 226 patients who underwent postoperative aEEG monitoring,approximately 5.8％ showed mild abnormal background patterns,0.9％ showed severe abnormalities,27.4％ demonstrated an immature SWC,and 3.5％ lacked SWC.The patients who had a history of hypoxia at birth exhibited delayed sternal closure or showed severe postoperative neurological symptoms and had higher probabilities of postoperative SWC abnormalities.Several infants,all with complex CHD,had postoperative seizures.Conclusion Gestational age and oxygen deficiency at birth were the risk factors of brain injury.Delayed sternal closure,severe postoperative infection,and postoperative neurological symptoms were risk factors for postoperative brain injury.Postoperative nervous system monitoring and prevention postoperative severe infection may obviously improve the brain function of neonates and small infants with critical congenital heart disease.

The Training Effect of Ability to Timely Screening for Congenital Heart Disease among Primary Medical Workers in Yunnan Province / 昆明医科大学学报

Objective To improve the early diagnosis of congenital heart disease (CHD), investigate the awareness, screening knowledge and screening ability of CHD among health care providers in the rural areas of Yunnan province and discover an effective way to improve the related knowledge and skills of CHD screening. Methods From 2015 September to 2017 April, we set up charity mobile schools and chose eight areas as the investigating and training sites. We designed two questionnaires, and adopted the theoretical training as the main method combined with the training of clinical skills. We investigated and trained a total of 1022 medical staff. The training content include the awareness of CHD,the knowledge and skills of CHD screening. We also evaluated the outcomes of the training. Results A total of 2044 questionnaires were collected. After training, the number of objects which would screen CHD in future increased, and the cognition of the incidence and common clinical manifestations of CHD, Eisenmanger's syndrome,cardiac auscultation, pulse oximetry and the related knowledge of CHD were also improved; 563 took the test on practical skills of CHD detection. The correct rate of auscultation, period of murmurs and characteristics of murmurs was 98.22%(553),30.55%(172) and 28.60%(161). The correct rate of murmurs in ventricular septal defect,atrial septal defect and patent ductus arteriosus was 45.47%(256), 39.79 (224) and 50.80%(286) respectively. Online training was advised by 244 trainees. Increasing investment in congenital heart disease screening was suggested by 652 trainees. Conclusions The awareness of CHD screening in grassroots medical workers of Yunnan province is insufficient. It is an effective way to establish charity mobile school and to train the grassroots medical staff with the theory and practical knowledge to improve the awareness,screening knowledge and screening skills of CHD. The next step suggests that we can improve the early diagnosis of congenital heart disease (CHD).

Newborn Pulse Oximetry Screening for Congenital Heart Disease / Монголын Анагаах Ухаан

@#Congenital heart disease (CHD) is one of the most common birth defects, with an incidence of nine out of every 1,000 live births. Critical CHD (CCHD) is defined as cardiac lesions that require surgery or cardiac catheterization within the first month (or within the first year by different definitions) of life to prevent death or severe end-organ damage. An early diagnosis and timely intervention can significantly reduce the likelihood of an adverse outcome. However, studies from the United States and other developed countries have shown that as many as 30%–50% of infants with CCHD are discharged after birth without being identified. Pulse oximetry is a tool to measure oxygen saturation, and based on the presence of hypoxemia, many cardiac lesions are detected. Due to its ease of application to the patient, providing results in a timely manner and without the need for calibrating the sensor probe, pulse oximetry offers many advantages as a screening tool. Pulse oximetry was recommended as a screening tool to detect critical CHD in 2011 by the American Academy of Pediatrics and the American Heart Association. Pulse oxymetry screening (POS) for early detection of CCHD is a simple, noninvasive, and inexpensive test, which meets the necessary criteria for inclusion to universal newborn screening panel. Wider acceptance and adoption can significantly decrease morbidity and mortality in infants with CCHD.

Pre-operative treatment in neonate with critical congenital heart diseases / 中国小儿急救医学

Objective To analyze the epidemiology and clinical features of the critical congenital heart diseases in neonates,and to summarize the main points on pre-operative treatments.Methods We retrospectively analyzed all critical congenital heart disease in newborns admitted to CICU from June 2014to June 2015.Depict entity distribution,the main symptoms,and the key points on their treatments,also the indi-cation of intubation and their operation time were summarized.Results In totally 96cases,transposition of the great artery,with and without the intact ventricle septum,was the biggest category and counts for 49%in our group.Severe cyanosis was the main symptom for 62.5% of all cases.Another key symptom was the heart failure(33.3%).Eight-seven cases were intubated during their treatments,in which 41were intubated as soon as they were admitted and 40cases were done in the first 24hours after their admission.One case died before treatment due to interrupted aortic arch.All the rest received operations during their hospital stay. Conclusion Transposition of great artery is the dominating entity in critical congenital heart diseases in new-borns;severe cyanosis is the main symptom.Treatment should be based on each characteristic anatomy and hemodynamics features.Rigorous and dynamic monitoring on the homeostasis and metabolic index determines the indication of intubation and surgery time.